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  1. eCQM Issue Tracker
  2. CQM-7715

Visit type for quality measures

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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      Hello, thank you for your inquiry. eCQMs rely on the associated codes listed in values on the Value Set Authority Center (VSAC) to capture the eligible visit type, also called an eligible encounter, and quality action measurement criteria of any particular measure. These coding elements are found in the data criteria of each eCQM measure specification. For example, in CMS122v13: Diabetes: Glycemic Status Assessment Greater Than 9%, documentation of an encounter code in the patient’s medical record from any of the measure’s qualifying encounter value sets would meet the Denominator’s qualifying encounter requirement. The measure’s quality actions are the eligible clinicians' responsibility. If the nurse and social worker mentioned in your inquiry are MIPS eligible clinicians, they may perform the quality actions such as a blood pressure measurement necessary to meet the measure criteria. For ease of review, the qualifying encounter value sets for CMS122v13 are listed below:

      "Encounter, Performed: Acute Inpatient" using "Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)"
      "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
      "Encounter, Performed: Emergency Department Evaluation and Management Visit" using "Emergency Department Evaluation and Management Visit (2.16.840.1.113883.3.464.1003.101.12.1010)"
      "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
      "Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)"
      "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
      "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
      "Encounter, Performed: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes" using "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes (HCPCS Code G0271)"
      "Encounter, Performed: Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes" using "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes (CPT Code 97804)"
      "Encounter, Performed: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes" using "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes (CPT Code 97802)"
      "Encounter, Performed: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes" using "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes (CPT Code 97803)"
      "Encounter, Performed: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes" using "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes (HCPCS Code G0270)"
      "Encounter, Performed: Nonacute Inpatient" using "Nonacute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1084)"
      "Encounter, Performed: Nutrition Services" using "Nutrition Services (2.16.840.1.113883.3.464.1003.1006)"
      "Encounter, Performed: Observation" using "Observation (2.16.840.1.113883.3.464.1003.101.12.1086)"
      "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
      "Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)"
      "Encounter, Performed: Palliative Care Encounter" using "Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090)"
      "Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
      "Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
      "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"

      Note, detailed eCQM measure specifications, which contain the value sets and coding required to report measures, can be downloaded and reviewed on the eCQI Resource Center page here https://ecqi.healthit.gov/. Value sets are located on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/ . The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications. For further information on MIPS eligible clinician types and requirements, please refer to the information located on the Quality Payment Program website: https://qpp.cms.gov/mips/how-eligibility-is-determined#mips-eligible-clinician-types . Thank you and please let us know if you have any further questions.
      Show
      Hello, thank you for your inquiry. eCQMs rely on the associated codes listed in values on the Value Set Authority Center (VSAC) to capture the eligible visit type, also called an eligible encounter, and quality action measurement criteria of any particular measure. These coding elements are found in the data criteria of each eCQM measure specification. For example, in CMS122v13: Diabetes: Glycemic Status Assessment Greater Than 9%, documentation of an encounter code in the patient’s medical record from any of the measure’s qualifying encounter value sets would meet the Denominator’s qualifying encounter requirement. The measure’s quality actions are the eligible clinicians' responsibility. If the nurse and social worker mentioned in your inquiry are MIPS eligible clinicians, they may perform the quality actions such as a blood pressure measurement necessary to meet the measure criteria. For ease of review, the qualifying encounter value sets for CMS122v13 are listed below: "Encounter, Performed: Acute Inpatient" using "Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)" "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)" "Encounter, Performed: Emergency Department Evaluation and Management Visit" using "Emergency Department Evaluation and Management Visit (2.16.840.1.113883.3.464.1003.101.12.1010)" "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)" "Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)" "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)" "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)" "Encounter, Performed: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes" using "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes (HCPCS Code G0271)" "Encounter, Performed: Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes" using "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes (CPT Code 97804)" "Encounter, Performed: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes" using "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes (CPT Code 97802)" "Encounter, Performed: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes" using "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes (CPT Code 97803)" "Encounter, Performed: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes" using "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes (HCPCS Code G0270)" "Encounter, Performed: Nonacute Inpatient" using "Nonacute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1084)" "Encounter, Performed: Nutrition Services" using "Nutrition Services (2.16.840.1.113883.3.464.1003.1006)" "Encounter, Performed: Observation" using "Observation (2.16.840.1.113883.3.464.1003.101.12.1086)" "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)" "Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)" "Encounter, Performed: Palliative Care Encounter" using "Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090)" "Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)" "Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)" "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)" Note, detailed eCQM measure specifications, which contain the value sets and coding required to report measures, can be downloaded and reviewed on the eCQI Resource Center page here https://ecqi.healthit.gov/ . Value sets are located on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/ . The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications. For further information on MIPS eligible clinician types and requirements, please refer to the information located on the Quality Payment Program website: https://qpp.cms.gov/mips/how-eligibility-is-determined#mips-eligible-clinician-types . Thank you and please let us know if you have any further questions.
    • CMS0022v13, CMS0050v13, CMS0056v13, CMS0068v14, CMS0069v13, CMS0074v14, CMS0075v13, CMS0090v14, CMS0117v13, CMS0122v13, CMS0124v13, CMS0125v13, CMS0128v13, CMS0129v14, CMS0130v13, CMS0131v13, CMS0133v13, CMS0135v13, CMS0136v14, CMS0137v13, CMS0138v13, CMS0139v13, CMS0142v13, CMS0143v13, CMS0144v13, CMS0145v13, CMS0146v13, CMS0149v13, CMS0153v13, CMS0154v13, CMS0155v13, CMS0156v13, CMS0157v13, CMS0159v13, CMS0165v13, CMS0177v13, CMS0249v7, CMS0314v2, CMS0347v8, CMS0349v7, CMS0645v8, CMS0646v5, CMS0771v6, CMS0951v3, CMS1056v1, CMS1056v2, CMS1157v1, CMS1188v2
    • Not sure how to pull data for the eCQM reports out of EHR

      Hello,

      Is there a list of eligible visit types that are acceptable for EP eCQMs? For example, if a nurse sees a patient for a POC A1C without seeing the provider (but the provider ordered the A1C), is that an acceptable value for CMS122? Another example, a social worker or PT sees a patient and takes a blood pressure, can that value be used for CMS22 or CMS165?

      Is there a list of acceptable visit types or does it have to be an actual provider (NP/PA/MD/DO) seeing the patient to qualify?

      Thanks!

            AIR EC eCQM Team AIR EC eCQM Team
            lthigpen Lindsay Thigpen
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